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Acne study points way to more effective cure

A pioneering acne study that took four years, 16 researchers and the gunk extracted from the nose pores of 101 volunteers has yielded surprising new insights — ones that could spur innovative new treatments for the age-old skin affliction.

“It’s a very interesting paper,” said Dr. Robert Dellavalle, an associate professor of dermatology at the University of Colorado who was not involved with the study.

Published Thursday in the Journal of Investigative Dermatology, the study used cutting-edge technology to analyze the connection between acne and the microbiome — the trillions of microbes that blanket our bodies.

Scientists have long recognized the link between acne and a bacterium called Propionibacterium acnes, or P. acnes. But how the bacteria causes pimples, or why it causes breakouts in some people and not others, is still poorly understood.

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In the new study, UCLA researchers used metagenomic sequencing, a powerful tool that can analyze the DNA of entire microbial communities. When they compared the bacterial profiles of healthy skin versus pimply skin, the results were “not what we expected,” according to lead author Dr. Huiying Li, an associate professor of molecular and medical pharmacology at UCLA.

For Li, the first surprise was that P. acnes dominated everyone’s pores, not just acne sufferers — it made up roughly 90 per cent of the microbial community inside the pores, regardless of skin type.

What differed between the two groups of volunteers were the strains of P. acnes.

“There were two kinds of strains that were mostly associated with acne, hardly found in any normal skin,” Li said. “That suggests these P. acne strains probably are linked to the disease.

“But more surprisingly — actually, more exciting for us — is we found that there is another strain, a third type of strain, that is mostly found in normal skin,” she said. “We had thought that P. acnes was the bad guy . . . we didn’t really think there could be a good one that could protect us.”

Technological innovations in the last decade have spurred an explosion of research into the microbiome, leading to all sorts of startling new medical insights about microbes’ impact on human health.

This new paper — which was funded by the Human Microbiome Project, an initiative to genetically sequence every human microbe — provides further evidence that bacteria can both harm and help us, said Dr. Richard Gallo, chief of dermatology at the University of California, San Diego.

Gallo, who was not involved with the study, said this paper is the first to show that acne sufferers may have different types of P. acnes.

“It provides an essential new understanding of the difference in the ecology between healthy skin and skin of patients with acne,” he wrote in an email.

Acne is a disfiguring skin disease and affects up to 85 per cent of teenagers and 11 per cent of adults, according to the paper.

The study, which took place between 2008 and 2011, enlisted 49 volunteers with acne and 52 people with healthy skin. Researchers collected their bacteria using over-the-counter cleansing strips, which are stuck to the wet nose and then peeled away, lifting out any whiteheads or blackheads.

Laboratory technician Bor-Han Chiu had the unenviable task of carefully collecting the nose pore “plugs” (called microcomedones) with a pair of sterilized tweezers — a painstaking process that took maybe 30 minutes per strip, according to Li.

Chiu said some strips had nearly a hundred plugs or “huge microcomedones” but those were easier; the difficult strips were from the healthy noses.

“For those with only one or two microcomedones, so tiny that they can barely be seen, searching through the strip several times can be energy consuming,” he wrote in an email.

Chiu then extracted the DNA, which he prepared for sequencing. More than 1,000 strains were isolated and researchers sequenced the genomes of 66 strains of P. acnes, many of which had never been sequenced before.

Li said the discovery of the “good” strain raises the possibility that P. acnes could even become an ally in the battle against bad skin.

The study’s findings also suggest that current medications, which wipe out all forms of P. acnes, may be too blunt a force.

The role of bacteria isn’t everything when it comes to acne, however, and many other factors also contribute to the disease, including a person’s immune system response or sebaceous gland activity.

But Li hopes her research could lead to customized treatments, tailored to each individual’s unique “cocktail” of skin bacteria.

“Acne is such an important disease but underemphasized because it’s not fatal,” she said. “It’s not considered as important, for example, as cancer. But so many people suffer from the disease (which can be) psychologically and socially disadvantageous.”

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